Must reside in California
Must have PharmD
Must CA License (non-restricted)
Remote
12 + months contract (could extend or become permanent)
Skills:
Thorough knowledge of therapeutic use of outpatient medications
Previous experience in prior authorization review
Microsoft Office (Outlook, Word, Copilot, etc.)
Prior experience with AuthAccel preferred.
Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of business
Apply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medications
Operate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframes
Serve as a resource to internal and external constituents regarding the drug formulary, medication policies and appropriate drug use
Embrace values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goal
Use clear and concise communications and on-brand messaging when communicating with providers or members
Follow all corporate policies and procedures
Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medications